伴窦道形成的Majocchi肉芽肿  

A case of Majocchi's granuloma with sinuses formation

作　　者：潘香君 徐瑾[1] 胡云峰[1] PAN Xiangjun;XU Jin;HU Yunfeng(Department of Dermatology,First Affiliated Hospital of Jinan University,Guangzhou 51630,,China)

机构地区：[1]暨南大学附属第一医院皮肤科,广东广州510630

出　　处：《临床皮肤科杂志》2023年第7期405-408,共4页Journal of Clinical Dermatology

基　　金：广州市科技计划(202102080331)资助项目。

摘　　要：报告1例伴窦道形成的Majocchi肉芽肿。患者男,42岁。左小腿多发红斑及溃疡伴瘙痒2个月余。皮肤科检查:左小腿见边界欠清的水肿性红斑,表面有2处浅表性溃疡,直径分别约1mm和5mm。溃疡下方伴窦道形成,挤压窦道口可见清亮的渗出液。窦道周围皮肤见粟粒大红色丘疹、丘疱疹及水疱,疱壁薄,疱液清亮,部分破溃伴渗出。皮损组织病理:真皮内可见毛囊周围炎,真皮全层混合炎症细胞、组织细胞及多核巨细胞浸润,并伴上皮样细胞肉芽肿形成。过碘酸希夫染色可见孢子及菌丝。窦道渗出液直接镜检:见菌丝。窦道渗出液真菌培养:可见表面白色,背面浅红色羊毛样菌落。分子生物学鉴定:红色毛癣菌。诊断:红色毛癣菌致Majocchi肉芽肿。予伊曲康唑口服,疗效佳,随访至今未复发。A case of Majocchi's granuloma with sinuses formation is reported.A 42-year-old male presented with multiple lesions of the left calf,,accompanied by pruritus for more than two months.Dermatological examination showed edematous erythema on the left calf with the unclear boundaries.There were two superficial ulcers with diameters of about 1mm and 5mm,respectively.During dressing change,sinuses were found to have formed below the ulcer,and clear exudate could be seen by squeezing the sinuses.The skin around the sinuses showed red papules of the size of millet,hilly herpes,blisters,thin blister wall,clear blister fluid,partial ulceration with exudation.Histopathology showed perifollicular inflammation in the dermis,in-filtrated by a mixture of inflammatory cells,histopathological cells,and multinucleated giant cells throughout the dermis,ac-companied by epithelioid granuloma formation.PAS stain showed fungal spores and hyphae.Direct microscopic examination of sinus exudate showed mycelia.Fungal culture of sinus exudate showed pale red woolly colonies on the back with a white surface.Molecular identification showed Trichophyton rubrum.The diagnosis of Majocchi's granuloma caused by Trichophyton rubrum was made.Oral itraconazole was effective and no recurrence was observed during the follow-up.

关 键 词：Majocchi肉芽肿 红色毛癣菌 窦道 

分 类 号：R756.6[医药卫生—皮肤病学与性病学]